U.S. Department of Labor

Employment Standards Administration Office Of Workers’ Compensation Programs Division of Energy Employees’ Compensation

Date                                                                            

File Number: 

Employee Name:       

Claimant:       

Name

Address

Address

Dear Mr./Mrs. Last Name:

This is in follow up to our letters of (Date) and (Date of second request) regarding your claim for benefits under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). Option 1We have not received a written response to date.  Option 2 You have advised us that you do not want to pursue a claim for impairment.

I would like to thank you for taking the time to consider our request to file for an award.  Please note that your decision at this time does not relinquish your right to file a claim for impairment in the future.  Therefore, we will not undertake further development for impairment at this time.  Should you wish to pursue a claim in the future, please notify us in writing at the address above.

If you have any questions about your claim or other benefits available under this program, do not hesitate to call me, toll-free, at ( )      .  If it is more convenient, you may visit one of our local resource centers for additional help. 

Sincerely,

Printed Name

Claims Examiner